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The delta variant is putting America’s hospitals back in crisis mode

A gathering outside an intubated patient’s room in the pediatric ICU at Arkansas Children’s Hospital in Little Rock on Aug. 5. (Michael S. Williamson/The Washington Post)
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With only about half of the U.S. population fully vaccinated against the novel coronavirus, hospitals across the country are straining to respond to a deadly fourth surge of infections driven by the delta variant.

Doctors say the nationwide outbreak overwhelming hospitals could have been avoided had more people been immunized. In the week ending Tuesday, 46 of the 50 states experienced double-digit growth in covid-19 hospitalizations, according to an analysis by The Washington Post. Eight states, including California and New York, which for most of the summer had not seen many serious cases, added more than 400 new inpatients in that time.

“It’s absolutely due to delta; it’s absolutely due to unvaccinated people,” said David Wohl, a specialist in infectious diseases at the University of North Carolina. “There is an incredible increase in hospitalizations across the spectrum, from just needing oxygen and some care to needing serious interventions to keep people alive. If everyone was vaccinated, our hospitals would not be anywhere near where we are,” Wohl said.

The delta variant has become the dominant strain of coronavirus in the United States, resulting in a rise in infections and hospitalizations. (Video: John Farrell/The Washington Post)

In rural Grants Pass, Ore., Asante Three Rivers Medical Center was already busy this summer. The hospital was struggling to fill positions, and people who had put off medical care during the pandemic were finally coming in.

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Then came the new wave of serious covid-19 cases — far more than the center had seen even in January. The entire critical care unit was filled Monday with unvaccinated patients, and a heartbroken doctor just told seven cancer patients their surgeries would have to wait. For the first time ever, the hospital is doubling up patients in critical care rooms where normally each would have had privacy.

“If you would have asked me … would we ever be there? I would have said, ‘God, I hope please we don’t get there,’” said hospital chief executive Win Howard, as some staffers doubled their hours and a nearby county asked the state for a 300-bed field hospital. “We are there today. It’s a sad day.”

The numbers paint a grim picture. For the week ending Aug. 15, the country reported 911,529 new infections, with an average of more than 130,000 cases a day, according to tracking by The Post.

The last time the weekly infection count was that high was the week ending Jan. 31, when the country logged 1,032,785 new infections, Post data shows.

At the time, vaccines were available only to vulnerable segments of the population.

The impact on hospitals is at once distressingly familiar and strikingly different from previous surges, clinicians say. In addition to handling mounting covid-19 case numbers, hospitals are playing catch-up on elective surgeries that were postponed because of the pandemic. People are out driving on the roads and playing sports, experiencing accidents and injuries, and increasing the burden on trauma departments. Common viruses are again spreading as people get together — and cases of respiratory syncytial virus (RSV) are filling up pediatric hospital beds. And administering new therapeutics, including monoclonal antibodies, is time-consuming.

‘This is real’: Fear and hope in an Arkansas pediatric ICU

All of this is putting extra demands on staffers who have not yet been able to process the previous surge, let alone rest. Now they are treating deathly sick patients who are younger than before — but would almost certainly not be in the hospital if they had been vaccinated.

“It’s kind of like running a race. We knew the finish line was a vaccine. Now, whoop, there is another half marathon in front of you,” said Lisa Clark Pickett, chief medical officer at Duke University Hospital in North Carolina. “We have seen so much death, and now it’s young people dying of things we can prevent.”

Pandemic burnout and other factors have also made hiring harder, said Jeff Absalon, chief physician executive for St. Charles Health System in Oregon, which is trying to fill some 800 open positions — more than double what might be seen in normal times. The health system has brought in about 100 traveling nurses.

“All of those things happening at the same time ... created this environment that we’re in right now,” he said.

With hospitals consistently full, Absalon’s health system scrambled this past weekend to open a new urgent care clinic at a site that’s normally used for primary care. Absalon is also having “extreme difficulty” discharging patients to skilled nursing facilities and assisted-living centers because of staffing shortages in those facilities, Absalon said. St. Charles Health System has started sending some of its employees to those facilities to provide care outside the hospital.

Greg Martin, a critical care doctor at Emory Healthcare in Atlanta and president of the Society of Critical Care Medicine, said that a few weeks ago, Atlanta was quiet. Since then, there has been a tenfold increase in the number of hospitalized patients — from 10 to more than 100 today.

“It’s remarkable how quick this surge has come on,” he said.

Hilo Medical Center on the Big Island of Hawaii just welcomed its first “relief workers” — 11 nurses and one respiratory therapist sent by FEMA and other authorities, said Elena Cabatu, director of public affairs. Now some staffers who have been “going nonstop for so long” can rest.

Cabatu wonders how sustainable that kind of help is when covid-19 cases are spiking around the country.

“If you look on the map, it’s red all over the place,” she said.

Many ER departments are particularly stressed because they have been giving remdesivir or monoclonal antibodies to patients who are showing signs of illness but are not sick enough to be hospitalized, according to Mark Rosenberg, president of the American College of Emergency Physicians and chair of emergency medicine at St. Joseph’s Health in Paterson and Wayne, N.J. The testing, preparation, infusion and observation can take a half-day or more.

“If you are seeing several hundred patients a day and a high percentage have covid and require treatment, this takes up a lot of resources and adds a lot of hours during the day,” Rosenberg said.

The strains on staffers reflect grim statistics. Don Williamson, president of the Alabama Hospital Association, said he has been watching the virus march up the state, starting with the counties abutting Florida, where more than 16,800 people are hospitalized with covid-19, occupying more than 30 percent of the state’s beds, according to federal data.

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In Alabama, more than 2,700 covid patients are hospitalized, about 400 fewer than the peak in January. But, Williamson said, ICU beds are already packed, even as hospitals adapt to provide more. The percentage of inpatients under 35 has increased from 8 or 9 percent to 16 percent. Back “in the golden days of June,” Williamson said, there were only about two or three pediatric covid patients in Alabama hospitals each day. Now that number is closer to 40.

Wohl, who monitors a dashboard that tracks hospital admissions at UNC, saw an uptick a couple of weeks after July 4.

“Holidays are good for covid-19 and bad for us,” Wohl said.

The delta variant, which delivers huge numbers of virus and accounts for nearly 100 percent of all new covid-19 cases, has presented new challenges, Wohl said, occasionally finding unexpected cracks in people’s immune systems sometimes even after they have been vaccinated. But in the vast majority of cases, people who get sick are unvaccinated.

“It’s extremely rare to see somebody vaccinated struggling to stay alive,” Wohl said.

The new variant has surprised experts in infectious diseases, according to Aaron Glatt, the chief of infectious diseases and the hospital epidemiologist at Mount Sinai South Nassau on Long Island.

With delta, “we are dealing a lot with guesses without knowing every piece of information that we’d ideally want to have,” Glatt said, adding that he is very concerned about the next few months.

“Nothing that I thought was going to happen happened,” Glatt said. “Delta is much more serious and contagious than I thought it would be.”

Many hospitals are already cutting back on routine work. Duke University Hospital has begun canceling some surgeries, including joint replacements and non-urgent hysterectomies.

“We hate to do that; it has long-term consequences,” Pickett said.

Tracking the coronavirus vaccine

In Oregon, Howard said that earlier in the pandemic, moves there to cancel elective surgeries were preemptive and mandated by the state. Now such deferrals are simply necessary, he said: The three-hospital system of which Three Rivers is a part has scrapped or pushed back hundreds of surgeries.

The system is licensed to operate 552 beds and is asking to add more than 100. It is also trying to fill about 550 job openings, far more than usual, and is turning more rooms into critical care spaces to handle coronavirus patients.

It’s not just the hospitals that are under pressure. The local ambulance companies are overwhelmed, too, Howard said. So are the skilled nursing homes to which medical centers say they have increasingly struggled to discharge patients, even before the delta wave. Open beds just aren’t staffed.

“We are averaging about 60 patients a day in our hospitals that don’t need to be there [but remain] because we can’t get them placed,” Howard said.

Tanya Phillips, an official with nearby Jackson County public health, said the entire public health system is strained, making contact-tracing difficult. Their region — Jackson and Josephine counties, including Grants Pass — had 163 people hospitalized with covid-19 on Monday.

The old peak, on Jan. 2, was 69.

The current situation “doesn’t really compare to what we saw during that fall and winter surge,” Phillips said. “It’s pretty surreal,” she added, saying 15 of the current covid-19 patients are on ventilators.

Wohl, the infectious-disease specialist at UNC, said that medical professionals are accustomed to treating people who have made bad decisions such as smoking, using drugs or driving dangerously. What is new this time, he said, is that they are treating people whose decision to forgo vaccination is, in many instances, based on misinformation and political manipulation.

“We sabotaged ourselves,” Wohl said. “It’s like watching the same house burn down time and time again.”

Jacqueline Dupree contributed to this report.

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